Provider Demographics
NPI:1639387673
Name:BRUEGGESTRAT, CARL VEITH (DMD)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:VEITH
Last Name:BRUEGGESTRAT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WEST CLARK ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-2517
Mailing Address - Country:US
Mailing Address - Phone:203-878-2151
Mailing Address - Fax:
Practice Address - Street 1:21 WEST CLARK ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-2517
Practice Address - Country:US
Practice Address - Phone:203-878-2151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT5774122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB9378969OtherUS DEPT OF JUSTICE
CT9550OtherCONTROLLED SUBST REGIST